An issue of great interest to couples who need an infertility treatment is the possibility of multiple pregnancy (twins, triplets etc.). Multiple pregnancy constitutes a well known complication of IVF, which may occur when 2 or more embryos are transferred.
IVF pregnancy achievement rates are known to increase along with the number of embryos transferred. In parallel though, the possibility of multiple pregnancy also increases. The ideal IVF result is one (1) healthy baby. However, twin pregnancies still are quite frequent (~20-25%). Most of them have positive outcomes; the possibility of premature birth is increased, though. In fact, some couples consider twin pregnancy a “blessing”, as they will not have to repeat IVF, so as to have their second child and complete their family. Actually, pregnancies with more than 2 embryos are those constituting a problem.
In any case, twin or triplet birth may entail severe problems. These may include complications during pregnancy, preterm labour and low birth weight, disability or increased neonatal death risk. Please read below more about risks for embryos and the mother, at www.oneatatime.org.uk
Risks for the child
At least half (50%) of twins are prematurely born (prior to 37 weeks of pregnancy, with full-term pregnancy reaching 40 weeks) and have low weight, which classifies them among “high risk” neonates with regards to severe health problems and neonatal death. Many of them are born prior to 35 weeks; then, hospitalisation in the neonatal unit is required. Twins weigh at birth 800-1000 gr less than normal.
More than 90% of triplets are born prior to 37 weeks, while some are born too prematurely, running a risk of developing severe health problems, which will be tormenting them for many years (if not for life) or even of dying soon after birth.
Risks for the mother
During pregnancy, a woman who is pregnant with twins or triplets has more chances of facing various problems, such as:
• Higher risk of miscarrying throughout pregnancy
• 20% of women pregnant with twins develop hypertension (in single pregnancies the percentage is 1-5%)
• The risk of pre-eclampsia reaches 30% (usually 2-10%)
• Possibility of developing diabetes: 12% (versus 4% in single pregnancies)
Especially regarding diabetes during pregnancy, it must be stressed that, although it doesn’t actually threaten the mother’s health, it increases the risk of embryonic or neonatal death.
As for labour and the puerperium, multiple pregnancy increases the risk of maternal bleeding and anaemia, as well as the possibility of developing stress and depression.
All the information above is available at www.oneatatime.org.uk. Please read more.
In Greece, the law in force states that up to 3 embryos can be transferred in patients under 40, while up to 4 embryos can be transferred in patients over 40 (the older a woman gets, the fewer her chances of becoming pregnant are). In other European countries, legislation is different, e.g. in the UK, no more than 2 embryos are allowed to be transferred in all cases, while in some clinics in Scandinavian countries only one (1) embryo is transferred (2 embryos are only transferred in patients above 40). However, it has been proved that this practice reduces total chances of achieving pregnancy.
At “gennima”, we try to avoid multiple pregnancy, which is risky for the pregnant woman as well as for the embryos. Thanks to the optimal operation of the embryology laboratory, allowing the development of higher quality embryos, i.e. embryos with better chances of implantation, we have been transferring 2 embryos in patients under 35, with exceptional pregnancy achievement rates. Thus, we avoid unpleasant therapeutic options, such as selective embryo reduction, during which one or more embryos are removed. The main complication of this operation is the miscarriage of the remaining embryos as well, and of course the psychological impact on the couple.
At “gennima” we believe that transferring 2 embryos is the best choice, thus we have high pregnancy achievement rates, as well as low multiple pregnancy rates. In any case, the couple is fully informed and has a thorough discussion with the doctor concerning the number of embryos to be transferred.